Safety and effectiveness of transurethral holmium laser enucleation of the prostate <i>versus</i> transurethral plasma kinetic enucleation of the prostate in the treatment of benign prostatic hyperplasia: a systematic review_West China Medical Journal

Authors：

PENG Lei ¹ , LI Jinze ² , YOU Chengyu ¹ , LI Xianhui ¹ , CHENG Bo ³ ,  LI Yunxiang ¹

1. Department of Urology, Nanchong Central Hospital, the Second Affiliated Medical College, North Sichuan Medical College (University), Nanchong, Sichuan 637000, P. R. China;
2. Department of Urology / Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
3. Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P. R. China;

Corresponding author：

LI Yunxiang, Email: liyunxiang369@126.com

Keywords：

Holmium laser enucleation of the prostate; Plasmakinetic enucleation of the prostate; Benign prostate hyperplasia; Randomized controlled trials; Meta-analysis

DOI：

10.7507/1002-0179.201911222

Video：

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Objective To evaluate the safety and clinical efficacy of transurethral holmium laser enucleation of the prostate (HoLEP) versus transurethral plasma kinetic enucleation of the prostate (PKEP) in the treatment of benign prostate hyperplasia (BPH).Methods Randomized controlled trials of HoLEP versus PKEP in the treatment of BPH published between January 2000 and March 2021 were searched in PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, Chongqing VIP database, and Wanfang database. Operative duration, estimated intraoperative blood loss, average duration of urinary catheterization, average duration of bladder irrigation, average length of hospital stay, and postoperative complications were used as safety evaluation indicators. Postoperative International Prostatic Symptomatic Score (IPSS), postoperative maximum urinary flow rate (Qmax), postoperative quality of life (QoL), and postvoid residual (PVR) were used as effective evaluation indicators.Results A total of 14 randomized controlled trials were included in this study, with a total of 1 478 patients (744 in the HoLEP group and 734 in the PKEP group). The results of the meta-analysis showed that the intraoperative blood loss in the HoLEP group was less than that in the PKEP group [weighted mean difference (WMD)=−25.95 mL, 95% confidence interval (CI) (−31.65, 20.25) mL, P=0.025], the average duration of urinary catheterization [WMD=−10.35 h, 95%CI (−18.25, −2.45) h, P=0.042], average duration of bladder irrigation [WMD=−10.28 h, 95%CI (−17.52, −3.04) h, P=0.038], and average length of hospital stay [WMD=−1.24 d, 95%CI (−1.85, −0.62) d, P=0.033] in the HoLEP group were shorter than those in the PKEP group, and the incidence of postoperative complications [risk ratio=0.70, 95%CI (0.56, 0.87), P=0.047] and 6-month postoperative Qmax [WMD=−0.89 m/s, 95%CI (−1.74, −0.05) m/s, P=0.037] in the HoLEP group were lower than those in the PKEP group. However, there was no significant difference in the operative duration, 3-month postoperative IPSS, 3-month postoperative Qmax, 3-month postoperative QoL, 3-month postoperative PVR, 6-month postoperative IPSS, 6-month postoperative QoL, or 6-month postoperative PVR between the two groups (P>0.05).Conclusions In the treatment of BPH, the effectiveness of HoLEP does not differ from that of PKEP, but HoLEP is safer. The conclusions of this study need to be verified in more precisely designed and larger sample-sized multi-center randomized controlled trials.

Citation： PENG Lei, LI Jinze, YOU Chengyu, LI Xianhui, CHENG Bo, LI Yunxiang. Safety and effectiveness of transurethral holmium laser enucleation of the prostate versus transurethral plasma kinetic enucleation of the prostate in the treatment of benign prostatic hyperplasia: a systematic review. West China Medical Journal, 2021, 36(7): 919-929. doi: 10.7507/1002-0179.201911222 Copy

1.	Gazel E, Kaya E, Yalcin S, et al. Comparison of the efficacy of holmium laser enucleation of the prostate in treating prostate volumes of ≤80 and > 80 mL. Urol Int, 2019, 102(3): 306-310.
2.	Johnsen NV, Kammann TJ, Marien T, et al. Comparison of holmium laser prostate enucleation outcomes in patients with or without preoperative urinary retention. J Urol, 2016, 195(4 Pt 1): 1021-1026.
3.	Li S, Kwong JS, Zeng XT, et al. Plasmakinetic resection technology for the treatment of benign prostatic hyperplasia: evidence from a systematic review and meta-analysis. Sci Rep, 2015, 5: 12002.
4.	Deng Z, Sun M, Zhu Y, et al. Thulium laser VapoResection of the prostate versus traditional transurethral resection of the prostate or transurethral plasmakinetic resection of prostate for benign prostatic obstruction: a systematic review and meta-analysis. World J Urol, 2018, 36(9): 1355-1364.
5.	Neill MG, Gilling PJ, Kennett KM, et al. Randomized trial comparing holmium laser enucleation of prostate with plasmakinetic enucleation of prostate for treatment of benign prostatic hyperplasia. Urology, 2006, 68(5): 1020-1024.
6.	Qian X, Liu H, Xu D, et al. Functional outcomes and complications following B-TURP versus HoLEP for the treatment of benign prostatic hyperplasia: a review of the literature and Meta-analysis. Aging Male, 2017, 20(3): 184-191.
7.	夏术阶, 钱雨鑫, 杨博宇. 良性前列腺增生症激光治疗的昨天、今天、明天. 现代泌尿外科杂志, 2019, 24(4): 252-255.
8.	王建文, 张孟冬, 平浩, 等. 前列腺等离子剜切术和钬激光剜除术治疗良性前列腺增生疗效分析. 中华男科学杂志, 2018, 24(12): 1084-1088.
9.	潘杰, 梁健峰, 陈举锋, 等. 经尿道前列腺钬激光剜除术与经尿道前列腺双极等离子剜除术治疗良性前列腺增生的近期疗效比较. 中国临床新医学, 2019, 12(2): 158-161.
10.	张豪杰, 盛璐, 陈然, 等. 经尿道钬激光前列腺剜除术与经尿道等离子前列腺剜除术治疗前列腺增生的疗效比较. 中国临床医学, 2016, 23(5): 636-639.
11.	Clark HD, Wells GA, Huët C, et al. Assessing the quality of randomized trials: reliability of the Jadad scale. Control Clin Trials, 1999, 20(5): 448-452.
12.	Higgins JP, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses. BMJ, 2003, 327(7414): 557-560.
13.	Wei Z, Tao Y, Gu M, et al. Plasma kinetic enucleation vs holmium laser enucleation for treating benign prostatic hyperplasia: a randomized controlled trial with a 3-year follow-up. J Endourol, 2021.
14.	程乃伟. 钬激光前列腺剜除术与经尿道等离子前列腺剜除术治疗良性前列腺增生的效果对比分析. 保健文汇, 2020(4): 283-284.
15.	黄应龙, 王金明, 李丹娜, 等. 主动保留尿控结构的HoLEP和TUPKEP疗效对比分析. 临床泌尿外科杂志, 2018, 33(9): 687-692.
16.	李树人, 郑鸣, 蒋庆祥, 等. 经尿道前列腺钬激光剜除术联合膀胱小切口与经尿道双极等离子前列腺剜除术治疗高危大体积前列腺增生的比较研究. 中国内镜杂志, 2015, 21(10): 1028-1032.
17.	林磊. 钬激光前列腺剜除术对良性前列腺增生患者术中出血量及术后生活质量的影响. 河南医学研究, 2017, 26(9): 1614-1615.
18.	刘强, 苟险峰, 李建国, 等. 经尿道等离子与钬激光前列腺剜除术治疗良性前列腺增生的疗效比较. 临床医药文献电子杂志, 2016, 3(20): 3969-3970.
19.	汪洋, 李志鹏, 蔡潜, 等. 经尿道前列腺等离子剜除术与前列腺钬激光剜除术的近期疗效比较. 昆明医科大学学报, 2016, 37(3): 52-56.
20.	王继前, 李超, 王永超, 等. 钬激光前列腺剜除术(HOLEP)与TUKEP治疗大体积良性前列腺增生疗效比较. 中国医疗器械信息, 2019, 25(23): 88-90.
21.	王子锋, 张宏, 杨群, 等. 钬激光前列腺剜除术与经尿道等离子前列腺剜除电切术治疗良性前列腺增生的效果对比. 中国综合临床, 2015, 31(9): 831-834.
22.	赵峰. 钬激光前列腺剜除术与经尿道等离子前列腺剜除电切术治疗良性前列腺增生的效果对比. 临床医药文献电子杂志, 2017, 4(83): 16312-16313.
23.	赵国瑛. 钬激光前列腺剜除术与经尿道等离子前列腺剜除电切术治疗良性前列腺增生患者的临床效果分析. 四川生理科学杂志, 2021, 43(2): 204-206.
24.	Zang YC, Deng XX, Yang DR, et al. Photoselective vaporization of the prostate with GreenLight 120-W laser versus transurethral resection of the prostate for benign prostatic hyperplasia: a systematic review with meta-analysis of randomized controlled trials. Lasers Med Sci, 2016, 31(2): 235-240.
25.	Xu N, Chen SH, Xue XY, et al. Older age and larger prostate volume are associated with stress urinary incontinence after plasmakinetic enucleation of the prostate. Biomed Res Int, 2017, 2017: 6923290.
26.	Zhao C, Yang H, Chen Z, et al. Thulium laser resection versus plasmakinetic resection of prostates in the treatment of benign prostate hyperplasia: a meta-analysis. J Laparoendosc Adv Surg Tech A, 2016, 26(10): 789-798.
27.	Cornu JN, Ahyai S, Bachmann A, et al. A systematic review and meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic obstruction: an update. Eur Urol, 2015, 67(6): 1066-1096.
28.	丁建东, 米磊, 王军卿. 钬激光剜除术的应用对良性前列腺增生治疗的安全性和有效性分析. 基层医学论坛, 2019, 23(10): 1365-1366.
29.	李国峰, 曹晓明. 激光和等离子技术在经尿道前列腺剜除术中的临床应用进展. 现代泌尿外科杂志, 2018, 23(9): 718-721.
30.	Rivera ME, Lingeman JE, Krambeck AE. Holmium laser enucleation of the prostate. J Endourol, 2018, 32(S1): S7-S9.
31.	罗建庭. 经尿道钬激光前列腺剜除术和经尿道前列腺电切术后疗效对比的Meta分析. 中国药物与临床, 2019, 19(7): 1176-1177.
32.	Wang SJ, Mu XN, Chen J, et al. Plasmakinetic enucleation of prostate versus 160-W laser photoselective vaporization for the treatment of benign prostatic hyperplasia. Asian J Androl, 2017, 19(1): 15-19.
33.	朱自强. 良性前列腺增生最新研究进展. 临床泌尿外科杂志, 2019, 34(5): 409-412.
34.	Das AK, Han TM, Hardacker TJ. Holmium laser enucleation of the prostate (HoLEP): size-independent gold standard for surgical management of benign prostatic hyperplasia. Can J Urol, 2020, 27(S3): 44-50.
35.	Feng L, Zhang D, Tian Y, et al. Thulium laser enucleation versus plasmakinetic enucleation of the prostate: a randomized trial of a single center. J Endourol, 2016, 30(6): 665-670.

1. Gazel E, Kaya E, Yalcin S, et al. Comparison of the efficacy of holmium laser enucleation of the prostate in treating prostate volumes of ≤80 and > 80 mL. Urol Int, 2019, 102(3): 306-310.
2. Johnsen NV, Kammann TJ, Marien T, et al. Comparison of holmium laser prostate enucleation outcomes in patients with or without preoperative urinary retention. J Urol, 2016, 195(4 Pt 1): 1021-1026.
3. Li S, Kwong JS, Zeng XT, et al. Plasmakinetic resection technology for the treatment of benign prostatic hyperplasia: evidence from a systematic review and meta-analysis. Sci Rep, 2015, 5: 12002.
4. Deng Z, Sun M, Zhu Y, et al. Thulium laser VapoResection of the prostate versus traditional transurethral resection of the prostate or transurethral plasmakinetic resection of prostate for benign prostatic obstruction: a systematic review and meta-analysis. World J Urol, 2018, 36(9): 1355-1364.
5. Neill MG, Gilling PJ, Kennett KM, et al. Randomized trial comparing holmium laser enucleation of prostate with plasmakinetic enucleation of prostate for treatment of benign prostatic hyperplasia. Urology, 2006, 68(5): 1020-1024.
6. Qian X, Liu H, Xu D, et al. Functional outcomes and complications following B-TURP versus HoLEP for the treatment of benign prostatic hyperplasia: a review of the literature and Meta-analysis. Aging Male, 2017, 20(3): 184-191.
7. 夏术阶, 钱雨鑫, 杨博宇. 良性前列腺增生症激光治疗的昨天、今天、明天. 现代泌尿外科杂志, 2019, 24(4): 252-255.
8. 王建文, 张孟冬, 平浩, 等. 前列腺等离子剜切术和钬激光剜除术治疗良性前列腺增生疗效分析. 中华男科学杂志, 2018, 24(12): 1084-1088.
9. 潘杰, 梁健峰, 陈举锋, 等. 经尿道前列腺钬激光剜除术与经尿道前列腺双极等离子剜除术治疗良性前列腺增生的近期疗效比较. 中国临床新医学, 2019, 12(2): 158-161.
10. 张豪杰, 盛璐, 陈然, 等. 经尿道钬激光前列腺剜除术与经尿道等离子前列腺剜除术治疗前列腺增生的疗效比较. 中国临床医学, 2016, 23(5): 636-639.
11. Clark HD, Wells GA, Huët C, et al. Assessing the quality of randomized trials: reliability of the Jadad scale. Control Clin Trials, 1999, 20(5): 448-452.
12. Higgins JP, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses. BMJ, 2003, 327(7414): 557-560.
13. Wei Z, Tao Y, Gu M, et al. Plasma kinetic enucleation vs holmium laser enucleation for treating benign prostatic hyperplasia: a randomized controlled trial with a 3-year follow-up. J Endourol, 2021.
14. 程乃伟. 钬激光前列腺剜除术与经尿道等离子前列腺剜除术治疗良性前列腺增生的效果对比分析. 保健文汇, 2020(4): 283-284.
15. 黄应龙, 王金明, 李丹娜, 等. 主动保留尿控结构的HoLEP和TUPKEP疗效对比分析. 临床泌尿外科杂志, 2018, 33(9): 687-692.
16. 李树人, 郑鸣, 蒋庆祥, 等. 经尿道前列腺钬激光剜除术联合膀胱小切口与经尿道双极等离子前列腺剜除术治疗高危大体积前列腺增生的比较研究. 中国内镜杂志, 2015, 21(10): 1028-1032.
17. 林磊. 钬激光前列腺剜除术对良性前列腺增生患者术中出血量及术后生活质量的影响. 河南医学研究, 2017, 26(9): 1614-1615.
18. 刘强, 苟险峰, 李建国, 等. 经尿道等离子与钬激光前列腺剜除术治疗良性前列腺增生的疗效比较. 临床医药文献电子杂志, 2016, 3(20): 3969-3970.
19. 汪洋, 李志鹏, 蔡潜, 等. 经尿道前列腺等离子剜除术与前列腺钬激光剜除术的近期疗效比较. 昆明医科大学学报, 2016, 37(3): 52-56.
20. 王继前, 李超, 王永超, 等. 钬激光前列腺剜除术(HOLEP)与TUKEP治疗大体积良性前列腺增生疗效比较. 中国医疗器械信息, 2019, 25(23): 88-90.
21. 王子锋, 张宏, 杨群, 等. 钬激光前列腺剜除术与经尿道等离子前列腺剜除电切术治疗良性前列腺增生的效果对比. 中国综合临床, 2015, 31(9): 831-834.
22. 赵峰. 钬激光前列腺剜除术与经尿道等离子前列腺剜除电切术治疗良性前列腺增生的效果对比. 临床医药文献电子杂志, 2017, 4(83): 16312-16313.
23. 赵国瑛. 钬激光前列腺剜除术与经尿道等离子前列腺剜除电切术治疗良性前列腺增生患者的临床效果分析. 四川生理科学杂志, 2021, 43(2): 204-206.
24. Zang YC, Deng XX, Yang DR, et al. Photoselective vaporization of the prostate with GreenLight 120-W laser versus transurethral resection of the prostate for benign prostatic hyperplasia: a systematic review with meta-analysis of randomized controlled trials. Lasers Med Sci, 2016, 31(2): 235-240.
25. Xu N, Chen SH, Xue XY, et al. Older age and larger prostate volume are associated with stress urinary incontinence after plasmakinetic enucleation of the prostate. Biomed Res Int, 2017, 2017: 6923290.
26. Zhao C, Yang H, Chen Z, et al. Thulium laser resection versus plasmakinetic resection of prostates in the treatment of benign prostate hyperplasia: a meta-analysis. J Laparoendosc Adv Surg Tech A, 2016, 26(10): 789-798.
27. Cornu JN, Ahyai S, Bachmann A, et al. A systematic review and meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic obstruction: an update. Eur Urol, 2015, 67(6): 1066-1096.
28. 丁建东, 米磊, 王军卿. 钬激光剜除术的应用对良性前列腺增生治疗的安全性和有效性分析. 基层医学论坛, 2019, 23(10): 1365-1366.
29. 李国峰, 曹晓明. 激光和等离子技术在经尿道前列腺剜除术中的临床应用进展. 现代泌尿外科杂志, 2018, 23(9): 718-721.
30. Rivera ME, Lingeman JE, Krambeck AE. Holmium laser enucleation of the prostate. J Endourol, 2018, 32(S1): S7-S9.
31. 罗建庭. 经尿道钬激光前列腺剜除术和经尿道前列腺电切术后疗效对比的Meta分析. 中国药物与临床, 2019, 19(7): 1176-1177.
32. Wang SJ, Mu XN, Chen J, et al. Plasmakinetic enucleation of prostate versus 160-W laser photoselective vaporization for the treatment of benign prostatic hyperplasia. Asian J Androl, 2017, 19(1): 15-19.
33. 朱自强. 良性前列腺增生最新研究进展. 临床泌尿外科杂志, 2019, 34(5): 409-412.
34. Das AK, Han TM, Hardacker TJ. Holmium laser enucleation of the prostate (HoLEP): size-independent gold standard for surgical management of benign prostatic hyperplasia. Can J Urol, 2020, 27(S3): 44-50.
35. Feng L, Zhang D, Tian Y, et al. Thulium laser enucleation versus plasmakinetic enucleation of the prostate: a randomized trial of a single center. J Endourol, 2016, 30(6): 665-670.

West China Medical Journal

Safety and effectiveness of transurethral holmium laser enucleation of the prostate versus transurethral plasma kinetic enucleation of the prostate in the treatment of benign prostatic hyperplasia: a systematic review

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